Integrating food & nutrition into your recreational program

1. Integrating food & nutrition into your recreational program Mohegan Tribe Special Diabetes Program Monica Farina RN, MS 11/4/11

2. What’s the issue? Looking at the situation: Diabetes & Youth Obesity M Farina RN

3. Acondition characterized by hyperglycemia resulting from the body's inability to use blood glucose for energy. • Type 1 diabetes, the pancreas no longer makes insulin and therefore blood glucose cannot enter the cells to be used for energy. • Type 2 diabetes, either the pancreas does not make enough insulin or the body is unable to use insulin correctly. M Farina RN

4. Why is childhood obesity considered a health problem? Doctors and scientists are concerned about the rise of obesity in children and youth because obesity may lead to the following health problems: •Heart disease, caused by: ◦high cholesterol and/or ◦high blood pressure •Type 2 diabetes •Asthma •Sleep apnea •Social discrimination New for children: bariatric surgery, depression, statins, hypertension, food addiction, isolation. www.cdc.gov/healthyweight/children M Farina RN

5. Healthy Weight 2010: Because more than one-third of children and more than two-thirds of adults in the United States are overweight or obese, the 7th edition of Dietary Guidelines for Americans places stronger emphasis on reducing calorie consumption and increasing physical activity. M Farina RN

6. What is food? M Farina RN

7. Some related issues (many others) Access to whole foods (Choice or Budget) Screen Time: SUGAR: American Heart Association: regular soft drinks provide about 33 percent of the added sugar consumed by Americans. A 12-oz. soda has around 8 tsp., providing all the extra sugar most individuals should consume in a day. M Farina RN

8. Community-Based Priorities for Improving Nutrition and Physical Activity in Childhood Report Shaping America Youth (SAY), 2004, documented how community efforts are motivated, funded, structured and evaluated. Town Meetings held; and participants perceived the barriers and solution similarly: • Family has primary responsibility, starting with need to focus on improved quality and duration of family time directed at nutrition and activity • Action from external influences: clear and consistent nutrition information; ready access to healthy foods, and a built environment to promoting physical activity • Rather than one-dimensional government solutions, they expressed a need for community-based partnerships integrating healthcare, education, environment, government and business http://pediatrics.aappublications.org/content/126/Supplement_2/S73.abstract, David A. McCarron, NinonRichartz, Steve Brigham, Molly K. White, Stephen P. Klein, and Samuel S. Kessel, Pediatrics 2010 M Farina RN

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10. Mohegan Program • Summer recreation program ages 6-12 • Had existing daily activities and recreation • Added: personal trainer to introduce different types of exercise, expanded to target groups by gender, & Presidents Council on Physical fitness • Collected BMI info each year • Added Nutrition the first 2 years: once a week hourly session for 4 weeks, successful • 3rd year added programming to address common problems with childhood nutrition: unhealthy lunches and snacks, sugary drinks M Farina RN

11. Project Goals • Minimum goal: increase awareness • Overarching goal: Behavior change child/family • Provide age appropriate education • Make it fun and interactive • Use different educational methods: games, incentives, food tasting, food challenge, lunch boxes, portion sizes, reading • Include staff as mentors • Create discussion M Farina RN

12. Program Planning Session 1: Fruit veg challenge/introduce Session 2: Healthy snack program Session 3: Serving Sizes & healthy snacks Session 3: Heart healthy foods Session 4: Food groups M Farina RN

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15. Bento boxes Portion control Fun Novelty but practical Encourages choices & whole foods Not pre-packaged “Make your own lunchable” Included recipe book 22.00- 29.00 each M Farina RN

16. Subway Fridays • Parent support!! • Kids all participated • Staff participated • Demonstrated: 1) Healthy selection from fast food menu 2) Healthy portion sizes 3) Healthy drink 4) Introduce choices Provided lunch from Healthy Choice Menu: Ham or turkey with cheese on whole wheat, 6 inch, baked chips, sliced apple, water M Farina RN

17. Nutritionists Perspective: Planning & Implementation M Farina RN

18. Healthy Snack Program • Consisted of 7 weeks of healthy snack samples and educational handouts. Each week a snack was distributed with a handout that explained the theme by comparing the chosen snack to an unhealthier one. • The goal of this program was for kids and their parents to choose more healthy foods for snacks and lunches. This was especially inspired by how often products like ‘lunchables’ were being brought in to camp. • Through trial and error, it was found that the handouts were more likely to make it home when they were distributed during the weekly nutrition lessons. At this time, a conversation was had about what the kids liked and disliked, and why the snack was chosen that week. Most kids liked the chosen snacks. • The biggest obstacle for this program was accessibility. It was difficult to find all of the snacks in local grocery stores in the quantities that were needed to distribute to all of the campers. It was also difficult to have access to refrigeration to keep the perishable snacks cold once they were purchased. Shannon Haynes RD, CD-N

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22. Shannon Haynes RD, CD-N

23. Nutrition Summer Camp Program • Consisted of a 4 week series of nutrition lessons. Each lesson was comprised of a hands-on nutrition education activity and a healthy snack for a group of 10-15 campers. Sometimes preparation of this snack was included. A handout was sent home with an overview of the activity performed, the snack that was served (recipe if applicable), and related nutrition info for parents. • Some activities included : • Healthy Snack and Lunch Bag Activity • Food Group Portion Bingo Game • My Plate Beading Activity • The Importance of Healthy Beverages and Tooth Health utilizing Sugar • Tube Models and Experiments with Boiled Eggs. • Fruit and Vegetable Challenge Contest • The “Eyes” Have It: Portion Distortion Stations • Yummy’s Fruit and Vegetable Food Group Game • Heart Health Lesson involving Occluded Artery Models and Fat Tube • Models. • Amount of Sugar in Different Snack Food Activity also utilizing Sugar Tube • Models Shannon Haynes RD, CD-N

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28. Teen Staff Nutrition Education Sessions • Consisted of 45-minute sessions that included: • A short PowerPoint presentation discussing nutrition basics, with • integration of reliable nutrition information websites. • A discussion about eating out and nutrition using websites of participants’ • favorite restaurants and food/beverage products. Meal and snack choices • were the focus of the lessons. • The relationship between food/beverages and exercise utilizing the NHLBI • Portion Distortion Quiz presentation. • Pre and post-test was utilized for evaluation of the education session. Shannon Haynes RD, CD-N

29. Shannon Haynes RD, CD-N

30. Pre and Post Test Results • Generally, both groups were able to document correct responses for pre and post test. The most significant improvement was in the second session where question 3 (Dunkin donuts menu) went from 54% to 92% answered correctly. • This pre/post-test could better demonstrate what the staff learned by using more specific questions about what was discussed in the presentation, like number 3. Question number 1 and 2 appear to have been too general and of common knowledge. Shannon Haynes RD, CD-N

31. Lessons Learned: • Healthy Snack Program: • When choosing snacks, go to the local grocery store with a list of possibilities and then make the final choices. • Choose snacks that can be stored safely with given situation. • Nutrition Lessons for Summer Camp: • Keep the groups small and manageable • Keep the lessons to no more than 30 minutes, not including snack time. • It may be necessary to change an activity to make it more age-appropriate in a camp setting. • Teen Staff Nutrition Education Sessions: • Even though most teens fundamentally know what is good and bad for them most of the time, they still need to talk about it repeatedly to make it more of their day-to-day thought process. This way it is still fresh in their mind when they make their daily food and beverage choices. • Make it applicable to their daily life. Shannon Haynes RD, CD-N

32. Final Report Considerations, budget, essentials, obstacles, and evaluation

33. Budget • Food: • Healthy Lunch 3.50-4.00 per person • Snacks or Drinks • Nutritionist hours: (CT $50-100 per hour) • Planning time: shopping? • Implementation time • Evaluation: surveys or reports • Supplies • Educational • Demonstration items: ingredients or visual • Incentives • Printing or marketing expenses • Program Planning Time: Your salary / hour Pick a level or venue: Children bring in healthy snacks & food challenge or Nutrition education session or Lunchboxes, provide lunch, snacks, or drinks M Farina RN

34. Budget Ways to keep costs down: Parent involvement of food purchase or charge Pilot interventions & increase if successful Share educational items Donations Volunteers to offset program planning time, or assist implementation time Food Challenge: children bring items in from home M Farina RN

35. Community Programming • Population needs are a moving target at best • Shift programming to be successful • Keep things simple • Be flexible • Everyone is clear on the goal, buys in, implementing changes • Make changes logically and hope for the best • Outcomes are not always predictable: + and – • Assign someone to track the program M Farina RN

36. Community Based Design • Lots of models and ideas available • Choose one that will have a chance of success within your budget • Gaining some experience may help you get additional grants or donation of time • Do the plan- resources, budget, personnel, accountability, working document, keep it simple, improves evaluation M Farina RN

37. Evaluation • Positive feedback children, parents, staff • Requests for all programming to continue • Raising awareness: 60 potential of children with direct nutrition education through a variety of venues • Extended outreach: siblings, parents, and grandparents • Overarching behavior change: only observational during program times 5 positive responses from parent, & 2 requests for additional counseling & information M Farina RN

38. Areas of Improvement • Complete analysis of BMI’s x 3 yrs • Comparative Presidents Council testing in subsequent years • Improve surveys and measurements • New staff training • Improve support from all key stakeholders M Farina RN

39. Expected obstacles • Parents are busy, many are working • Kids are overscheduled • Reliance on processed food to manage • Sedentary habits, technology influences • Cooking…. Take Out…Semi homemade • Parenting and priorities • Confusing nutrition labels & marketing • Long-standing habits • Staff is busy with usual programming CHANGE !! M Farina RN

40. Reaching Out beyond programming • Remove blame and guilt • Help understand outside influences • Encourage small steps, one at a time • Build confidence • Be enthusiastic • Be complimentary • Be open to feedback • Foster community partnerships and referrals M Farina RN